Frequently Asked Questions about Amblyopia & Strabismus
WHY DOES IT OCCUR? Most eye doctors consider a “lazy eye” to be an eye with amblyopia or strabismus. Up to 4% of children have amblyopia and strabismus, making it a very common problem. Patients with AMBLYOPIA have a structurally intact eye, but their vision that does not normalize immediately despite the appropriate glasses correction. Amblyopia is most frequently due to misaligned eyes (strabismus). However even small differences in the length or shape of one eye compared to the other can cause amblyopia. Droopy eyelids, warped corneas, cataracts or rarely intraocular growths can cause amblyopia.
If amblyopia is detected well before the child is 5-8 years old, it is much easier to correct. Amblyopia treatment usually requires the stronger eye to be patched (or given atropine eye drops), in addition to glasses.
Amblyopia and strabismus can occur in children whose parents have normal eyes, but are more common if one or both parents have a lazy eye. It is counterproductive to blame one spouse, or one side of the family for your child’s problem. Use your time to help your child rather than trying to divide the family.
I DON’T WANT MY CHILD IN GLASSES. As a physician and father I greatly respect parents who think they are advocating for their children. However, do not let your personal biases get in the way of what is best for your child. Some parents strongly resent putting their child in glasses thinking that their child will be made fun of. Just imagine how much torment your child will have to put up with if he/she can’t see. Most parents would not hesitate to obtain extra tutoring for their child if they had problems with scholastics. It is difficult to comprehend why these same parents would not allow glasses to help their child’s weak or crooked eyes. The glasses may not be permanent. When the child is older, contact lenses can sometimes be used. When your child is fully grown, laser corrective surgery might be an option too.
IF MY CHILD CAN’T TALK, HOW DOES THE DOCTOR DETERMINE WHICH GLASSES PRESCRIPTION IS RIGHT FOR MY CHILD? With the use of eye drops and special instruments, eye doctors can determine when light is in best focus for a child’s eye. Your eye doctor has gone through years of training to accomplish this task.
WHEN I PUT MY CHILD’S GLASSES ON THEY SEEM TOO STRONG. Most adults realize it is silly to try and fit into young children’s clothing. The clothing is too tight and uncomfortable! The same applies to your child’s glasses. Your child’s eye is not the same size as yours. Glasses that may seem strong to you, are appropriate for your child. The glasses prescription must bend the light to the correct focus on the retina.
MY CHILD WILL NOT ALLOW ME TO PATCH More benefit will be obtained if amblyopia is diagnosed and treated well before the age of 8 yo. After this age, patching can still be done, but it is harder to improve the vision. Playing “peek-a-boo” with the child may be a gentle introduction to patching. Children can be allowed to decorate their patch. Patch time can be associated with the use of video games. Patching during dinner time or car rides (with the other parent driving) may work. Cloth patches that fit over the glass arm and nose pad are available, or can be made. In some cases you may just have to exert your parental influence, and realize despite the crying, struggling and frustration, you are doing what is best for your child.
Placing mittens on the child will make it more difficult for them to remove the patch. Some parents tape use a rolled-up magazine on the inside of the elbow as a splint so that the child cannot bend their arms and remove the patch. Elbow splints are commercially available.
In children refusing to patch, atropine drops can be placed in the better seeing eye in lieu of a patch.
Amblyz glasses are also available, but are expensive and will not work unless your child is willing to wear glasses.
WHAT HAPPENS TO MY CHILD IF I CHOOSE NOT TO PATCH OR DON’T USE THE GLASSES THE DOCTOR WANTS ME TO? Vision is a “learned” phenomenon. Your child must learn to see, and have visual stimulation from the first weeks of life in order to develop normal vision. After 8 years of age it is much more difficult, and in some patients not possible to improve vision despite glasses, eyedrops, patching, laser or other surgery. (We still try to patch teenagers and even some adults with amblyopia, but the potential for marked gains in vision is less than in young children.)
I WANT THE SURGEON TO OPERATE ON MY CHILD’S CROOKED EYES, BUT HE WON’T. Surgeons like to operate, but only if it is in the patient’s best interests. There must be a reason why your surgeon is not recommending surgery. If your child has a focusing problem that is fixed by eyeglasses, we usually do not operate, since surgery may not help your child in the long term.
DOES “VISION THERAPY” WORK The link to the 2022 Canadian Ophthalmologic Society Position Statement on Vision Therapy is here. https://www.cosprc.ca/position-statement-by-the-canadian-ophthalmological-society-cos-regarding-vision-therapy-vt-or-behavioural-optometry/
THE SURGEON SUGGESTS SURGERY, BUT I DON’T WANT MY CHILD OPERATED ON Sometimes surgery can be delayed as long as glasses and patching are continued. Parents have the option of visiting with the anaesthesia doctor to alleviate concerns about anesthesia. It is possible for “bad things” to happen in the operating room. However the risk of adverse events occurring is in general less than the risk of getting in a serious automobile accident. In general, if you smoke in front of your child, or let your child play street hockey without protective gear, or let your child ride a bike without a helmet, you’re accepting a higher risk of injury, than in the operating room.
IF I PATCHED MY CHILD LONGER, WILL THE EYES STRAIGHTEN WITHOUT SURGERY? NO. When you patch, the weak eye appears straight, but the stronger eye underneath the patch is crooked. If you look closely at your child when removing the patch, you will notice that only one eye at a time remains straight.
THE DOCTOR WANTS TO OPERATE ON BOTH EYES, BUT ONLY ONE EYE SEEMS CROOKED. Sometimes Dr. Ing recommends surgery on both eyes, so that there will be better “balance”. However if despite patching, one eye is “blind”, we usually operate on the worst seeing eye first.
If your child sees well but has troubles reading, dyslexia may be the problem. Many famous people have had dyslexia.
Overcoming dyslexia requires persistence. Children and parents may appreciate the book, “Ben and Emma’s Big Hit”. written by Governor Newsom.
MYOPIA AND LOW DOSE ATROPINE EYE DROPS
In a North American trial, low-dose (0.01%) atropine eyedrops no better than placebo for slowing myopia progression.
Repka MX, et al., on behalf of the Pediatric Eye Disease Investigator Group. “Randomized trial of low-dose atropine eyedrops for myopia control(link is external)”, published July 13, 2023 in JAMA Ophthalmology.